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UC HEALTH LINE: Schizophrenia Misunderstood, Psychiatrist Says

CINCINNATI—Most people have heard the term "schizophrenia” and are aware that it’s a mental disorder. Unfortunately, a UC Health psychiatrist says, few people actually understand what schizophrenia is or how pervasively it affects society.

"Schizophrenia is a very serious disabling brain disease that affects people in the prime of life—usually late adolescence or early 20s,” says Henry Nasrallah, MD, a professor in the University of Cincinnati (UC) Department of Psychiatry and Behavioral Neuroscience, director of the schizophrenia program and editor-in-chief of the international journal Schizophrenia Research.

According to the National Institute of Mental Health, about 1 percent of Americans—3 million people—have schizophrenia. It’s characterized by multiple clusters of symptoms, including:

·Psychotic symptoms: These include delusions, which are fixed, false beliefs, of which paranoia is the most common. "They feel somebody’s out to get them,” Nasrallah says. "The delusions can also be bizarre, such as believing that somebody on the moon is sending beams into their head and controlling their actions.” Another prominent psychotic symptom, Nasrallah says, is hallucinations—most frequently auditory, but sometimes visual of people or animals, or abnormal taste or odors.

·Negative symptoms: These symptoms are particularly disabling, Nasrallah says, because—unlike psychosis—no treatment is yet available for them. People with negative symptoms are unable to initiate action, are unmotivated, lack social skills, have an expressionless face and do not speak much.

·Cognitive deficits: "They can’t use their brain functions like other people do,” says Nasrallah. "Their memory, attention, concentration and decision-making are poor. It’s also hard for them to learn and remember new things.”

It’s important to know that schizophrenia is not "split personality,” Nasrallah says. That’s a common misconception that dates from 1911, when Swiss psychiatrist Eugen Bleuler coined the term "schizophrenia.” It comes from the Greek roots schizo (split) and phrene (mind); Bleuler used it to describe "scattered thoughts.” (Split personality is actually known as dissociative identity disorder.)

Schizophrenia has both genetic and environmental causes, Nasrallah says.

There are many reasons why schizophrenia symptoms commonly don’t appear until late adolescence or the early 20s, Nasrallah says, including hormonal changes and the stresses of becoming independent. Additionally, it takes years for the brain to mature structurally and the two regions of the brain that are abnormal in schizophrenia—the hippocampus and the prefrontal cortex—are the last ones to mature in late adolescence.

Because many of the psychological causes of schizophrenia are still unknown, treatments focus on suppressing the symptoms of the disease. Treatments include antipsychotic medications and various psychosocial treatments, such as supportive therapy, social skills training and vocational rehabilitation. However, the vast majority of people with schizophrenia become disabled and cannot return to school or get a job.

Nasrallah says society has struggled to manage schizophrenia since states began closing psychiatric hospitals in the 1960s. "They promised to transfer money into community care, but they didn’t,” he says. "So we have a very broken public mental care system in the United States, where people with schizophrenia are often incarcerated in prisons and jails and are transformed into felons instead of patients.

"This is an absolute injustice to these sick individuals who must be treated, not jailed.”

Additionally, he says, people with schizophrenia tend to lead sedentary lives with unhealthy habits such as smoking and overeating and some of their medications cause obesity, high lipids and diabetes, so they die 20 to 25 years earlier than the general population.

Still, there are reasons for optimism, Nasrallah says.

"There’s never been a more exciting time to be a schizophrenia researcher,” he says. "There has been an explosion of neuroscience advances, and we have learned tremendous amounts about the neurobiology of schizophrenia down to the cellular and molecular level. Breakthroughs will definitely lead to better treatments and even prevention.”